title: Pharmacodynamic target attainment with high-dose extended-interval tobramycin therapy in patients with cystic fibrosis.
abstract: Utilization of high-dose extended-interval aminoglycoside therapy (HEAT) in patients with cystic fibrosis (CF) is supported by primary literature and national guidelines. We sought to evaluate the effectiveness of a local aminoglycoside guideline to achieve pharmacodynamic goals in patients with CF that received ≧3 doses of HEAT from 2005 to 2011. Patients with renal dysfunction at baseline, status-post-lung transplant, or receiving inhaled tobramycin were excluded. In the 282 patient admissions, the average initial tobramycin dose was 10·3 mg/kg with an average initial peak of 21·5 mg/l. At least one dose titration was seen in 39% of patients. Patients who achieved the pharmacodynamic goal received a higher dose (10·4 mg/kg versus 9·7 mg/kg; P<0·001). A mean starting dose of tobramycin at 10·3 mg/kg every 24 hours achieved an average peak above goal. Higher initial dosing resulted in a higher likelihood of achieving the pharmacodynamic goal.
authors.forename: Jeremy R
authors.initials: JR
authors.lastname: DeGrado
authors.forename: Deborah
authors.initials: D
authors.lastname: Cios
authors.forename: Bonnie C
authors.initials: BC
authors.lastname: Greenwood
authors.forename: David W
authors.initials: DW
authors.lastname: Kubiak
authors.forename: Paul M
authors.initials: PM
authors.lastname: Szumita
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000493:pharmacokinetics; D003550:Cystic Fibrosis / Q000188:drug therapy* / Q000378:metabolism; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D014031:Tobramycin / Q000008:administration & dosage* / Q000493:pharmacokinetics
chemical_list: D000900:Anti-Bacterial Agents; D014031:Tobramycin
keywords: Aminoglycosides,; Cystic fibrosis,; Pharmacodynamics; Tobramycin,